Two people entering a clinic at Highland Hospital in Oakland. Alameda Health Services, which operates Highland, is still requiring staff and visitors to wear masks inside, even though Alameda County no longer requires it. Credit: Amir Aziz

As of yesterday, healthcare workers and others in California are no longer required by the state to wear masks at hospitals or other high-risk indoor settings such as jails, prisons, and homeless shelters. While individual counties can still require people to wear masks inside healthcare facilities, Alameda County hasn’t done so and has chosen instead to follow state guidelines that encourage but don’t require masking. 

In recent days, Oakland-based disabled and immunocompromised individuals, seniors, doctors, and others concerned with public health have participated in protests, call-ins, and letter-writing campaigns calling on Alameda County and its top health officer Dr. Nicholas Moss to continue requiring mask-wearing in healthcare facilities. The county health department issued a mandate on March 27 requiring staff at skilled nursing facilities to wear masks while working with residents, but the order did not include other healthcare settings, including hospitals and clinics. 

In the absence of a state or county mask mandate, large healthcare providers operating in Oakland have been creating their own policies. While some are dropping the requirement for their workers, patients, and visitors, others are keeping mask mandates to varying degrees.

Two of the biggest providers in Oakland, Kaiser Permanente, and Sutter Health, have stopped requiring masks in most cases. Sutter Health told physicians and clinicians in a memo on March 28 that “masking is recommended but no longer required within most patient care settings,” but that staff must still wear masks when treating patients with “known or suspected airborne transmissible disease,” such as COVID-19. 

In an emailed statement, a spokesperson told The Oaklandside that Sutter recommends masking, will provide PPE to all who enter its facilities and is basing its masking policy on recommendations from public health officials. The spokesperson added that Sutter is “continuously monitoring this situation and will adjust our guidance if needed to help ensure the safety of our patients, employees, and physicians.”

Sutter will also continue “to require masks for patient care in transplant units and infusion centers.”

Kaiser updated its website on March 31 to inform visitors to their hospitals and clinics that “masks are no longer required at Kaiser Permanente facilities,” unless they are mandated by the government, regulatory agencies, or local infection prevention experts. Visitors also no longer have to show proof of vaccination or a negative COVID-19 test to visit friends or family in the hospital.

In an email, a spokesperson told The Oaklandside that Kaiser will “monitor and adhere to all applicable federal, state, and local regulations regarding masking.” The spokesperson also confirmed that masking is no longer required for all staff, except for “in designated circumstances and clinical areas.” This includes masking while in operating rooms, and after being exposed to COVID-19 or within 10 days of testing positive for the virus.

“We respect every person’s choice to voluntarily wear a mask, and to ask their health care provider to wear a mask, even in areas where they are not required,” the spokesperson added.

Alameda Health System, a public network that is separate from the Alameda County Public Health Department and operates nine facilities in the East Bay including Highland Hospital and the Eastmont Wellness clinic in Oakland, will continue to require masking in most cases. AHS issued a memo to staff on March 28 stating that masking is still required for workers and visitors to their facilities. 

Alameda Health System’s chief medical officer, Dr. Felicia Tornabene, confirmed to The Oaklandside in a statement that the policy also applies to patients.

“We will continue to require masks in high-risk settings because we are still caring for significant numbers of COVID-19 patients in our health system,” said Tornabene. “That means that AHS staff, patients, and visitors will be required to wear masks in patient care areas.”

UCSF Benioff Children’s Hospital, the only hospital that cares exclusively for children in Oakland, is operating under a new policy that mandates staff and students at the hospital to mask in indoor clinical areas as well as elevators and lobbies. Patients and visitors, however, no longer have to wear masks.

Smaller healthcare providers across Oakland such as community-based clinics, private doctors, and dentists are also no longer bound by state law to require masking, although they are free to create such requirements if they choose to, and policies will vary from site to site.

Hospital masking requirements remain in some other California counties. San Francisco and Los Angeles counties have issued mandates requiring all staff and personnel, but not visitors or patients, to mask at healthcare facilities. In Santa Clara County, masks must be worn by staff, patients and visitors in patient-care areas only during a “winter respiratory virus period” between Nov. 1 and March 31 of each year. 

Vulnerable patients say less-strict masking policies put them at risk

Some Oakland residents with conditions that put them at increased risk for catching COVID-19 and/or developing severe symptoms, including death, told The Oaklandside that the recent changes in masking policies have made accessing healthcare more dangerous, difficult, and potentially expensive for them. 

Oakland resident Dorothy Graham, 72, told The Oaklandside that for the first time, she feels like she “can’t get any care for my conditions” without placing her life at risk. For Graham, catching COVID-19 poses increased risks due to her having bronchiectasis, a long-term condition that causes difficulty breathing and a heightened risk of developing lung infections. Graham is retired and her previous employer, which provides her healthcare, requires her to seek care through Kaiser Permanente. Due to her age and her conditions, she says she wouldn’t able to afford healthcare elsewhere.

“With my health problems I’m uninsurable elsewhere,” said Graham. “There is no other option for me, I have to stay at Kaiser.”

Graham has been limiting her risk by not going indoors other than inside her home, even to visit her family, except when she has to seek essential medical care. She got one dose of the COVID-19 vaccine but had an adverse reaction and said she couldn’t take other doses.

Graham has caught pneumonia multiple times, and said the next time she gets it “my life is going to be at risk” because she will be forced to either forego treatment or take the risk of getting COVID-19 at a healthcare facility, which her doctor said would put her at “extreme risk for adverse outcomes, up to and including death.”

“If you have a chronic illness and you have no ability to get safe care, it can be a death sentence,” Graham said. “I’m going to face decisions the next time I get sick that no person should have to make.”

Graham emphasized that others need safe access to medical care as well, such as cancer patients who are seeking chemotherapy treatment, a population at extreme risk for COVID due to having weakened immune systems.

“I don’t want to imply in any way that I’m unique because I’m not alone,” said Graham, who worked in the public health field for 40 years before retiring. “Cancer patients are getting chemotherapy, but [Kaiser] isn’t even requiring masking in those buildings.”

The Oaklandside asked spokespeople from Sutter and Kaiser how they thought dropping a mask mandate would affect those who are immunocompromised, but we did not receive an answer.

Oakland resident Beth Kenny, who has an autoimmune disorder and frequently needs to seek care, has also been told their condition puts them at an increased risk for death if they catch COVID. They currently get healthcare with a Kaiser policy through their wife’s employer. They are able to switch plans but estimate that doing so would increase their monthly healthcare costs by over $1,000, due in large part to one of their medications costing over six times what it currently does at Kaiser.

Kenny, who has been organizing with Senior and Disability Action, believes universal masking at healthcare facilities would create a safer environment for people who need to access care. Such masking has been proven to be much more effective at stopping the spread of COVID than when just one person masks.

“I don’t think public health should be based off of how people are feeling [about the pandemic], it should be based on… people’s health,” said Kenny. “This system has failed us.”

Correction: This article previously stated that medical staff at Kaiser are required to wear masks while performing lumbar injections. They are not.

Journalist and poet writing about homelessness, housing, and activism in Oakland and the East Bay.